How do lymph nodes work and why do they enlarge?
Lymph is collected from tissues and passes through chains of lymph nodes, where immune cells recognize germs and foreign particles. When encountering a pathogen, the cells in the node multiply rapidly and the node enlarges. This reaction is natural and reversible. The location of the enlarged node suggests the search area: submandibular and cervical nodes react to diseases of the teeth, throat and ear, axillary nodes - to the skin of the hand and mammary gland, inguinal nodes - to the legs and perineal area. Nodes above the collarbone deserve special attention at any age.
- Reactive lymphadenopathy due to nearby infection
- Local — nodes of one area have been enlarged
- Generalized - nodes in several areas
- Lymphadenitis is the actual inflammation of the node
- Tumor lesion: lymphoma or metastasis
Common reasons
The vast majority of cases are associated with infections. In children and young adults, these are respiratory viruses, tonsillitis, infectious mononucleosis, dental diseases, infected wounds and bites. A separate category is cat scratch disease, in which the nodule enlarges one to two weeks after contact with a cat. Of the chronic infections, tuberculosis is important; HIV, toxoplasmosis, and brucellosis are also significant. Non-infectious causes include autoimmune diseases, drug reactions, sarcoidosis, and lymphomas and tumor metastases.
- Respiratory viral infections and sore throat
- Dental and ENT infections
- Infectious mononucleosis
- Cat scratch disease
- Tuberculosis of the lymph nodes
- HIV, toxoplasmosis, brucellosis
- Autoimmune diseases and sarcoidosis
- Lymphomas and tumor metastases
Which nodes should you be wary of?
The doctor evaluates not only the size, but also the characteristics of the node. The reactive node during infection is soft or elastic, painful, mobile, the skin over it is not changed, and after a few weeks the node decreases. A tumor node, on the contrary, is usually dense, painless, inactive and gradually growing. Localization is also important: the node above the collarbone requires examination in any case. The combination of enlarged nodes with fever without obvious infection, night sweats, weight loss, itching, and changes in blood tests is alarming.
- Density and immobility of the node
- No pain during growth
- Size greater than 2 cm and increasing over time
- Supraclavicular localization
- Duration longer than 4–6 weeks
- General symptoms: fever, sweating, weight loss
Survey
The first step is to examine and search for the source of infection: the doctor checks the throat, teeth, and skin in the area of lymph drainage. A complete blood count helps distinguish a bacterial infection from a viral one and notice changes characteristic of blood diseases. Ultrasound clarifies the size, structure of the node and blood flow, which helps to distinguish reactive changes from suspicious ones. For generalized lymphadenopathy, they are examined for infections and autoimmune diseases, and a chest x-ray is prescribed. The decisive method for persistent enlargement remains biopsy of the node with histological examination.
- Examination of all groups of lymph nodes, liver and spleen
- General blood test with formula
- C-reactive protein
- Ultrasound of lymph nodes
- Chest X-ray
- Tests for HIV, hepatitis, tuberculosis, toxoplasmosis
- Lymph node biopsy with histology with persistent enlargement
- Computed tomography as prescribed by a doctor
What to do and how to treat it
The tactic depends on the reason. If an infection is evident, it is treated, and the nodule usually shrinks on its own within a few weeks - sometimes a small, dense nodule persists for months and does not require intervention. It is impossible to heat the nodes, do compresses and physiotherapy without a prescription: in the case of a purulent or tumor process, this worsens the situation. Antibiotics are prescribed only for bacterial infections. If the nature is unclear or there are alarming signs, the doctor does not postpone the biopsy: timely diagnosis of lymphoma directly affects the outcome of treatment.
- Treatment of the main infectious focus
- Observation for 2–4 weeks for a typical reactive picture
- Refusal of warming up and compresses
- Antibiotics only as prescribed by a doctor
- Dental sanitation and treatment of ENT lesions
- Biopsy for persistent or suspicious nodule
- Profile treatment for confirmed lymphoma or tuberculosis
